Provider Demographics
NPI:1235304189
Name:BURGGMAN, THOMAS M (LCPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BURGGMAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1411
Mailing Address - Country:US
Mailing Address - Phone:410-744-9100
Mailing Address - Fax:410-747-0226
Practice Address - Street 1:5602 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 508
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1411
Practice Address - Country:US
Practice Address - Phone:410-744-9100
Practice Address - Fax:410-747-0226
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401254200Medicaid
MD403344200Medicaid